37 Pa. Code § 171.154
The following is the form for request for conciliation conference:
COMMONWEALTH OF
PENNSYLVANIA
ARBITRATION PANELS FOR
HEALTH CARE
| : | ||
| : | No. | |
| vs. | : | |
| : | County: | |
| : | (Form of action) | |

This section cited in 37 Pa. Code § 171.61 (relating to conciliation conference).